Ovarian
Ovarian Cancer: The Facts and Statistics
Ovarian cancer is the leading cause of death from gynecologic cancers in the United States, and is the fifth leading cause of cancer death among U.S. women. According to the American Cancer Society, it is estimated that 22,430 women will be diagnosed with this cancer in the U.S. in 2007, and about 15,280 women will die from the disease. A woman’s lifetime risk of ovarian cancer is 1 in 67; it is an insidious disease that often strikes without warning and without cause. The symptoms of ovarian cancer are often vague and subtle, making it difficult to diagnose.
Currently there is no effective means of early detection for the disease. As a result, ovarian cancer is usually diagnosed in advanced stages and only 50% of women survive longer than five years. Today, only 25% of cases are diagnosed in the early stages, i.e., before the cancer has spread beyond the ovary to the pelvic region. However, if ovarian cancer is detected and treated early, the five-year survival rate is greater than 90%.
Until we have an effective way to detect ovarian cancer, we urge all women to become educated about the disease so she can act independently to protect her health.
Signs & Symptoms of Ovarian Cancer
Listen to your body. Do not ignore symptoms.
• Vague but persistent and unexplained gastrointestinal complaints such as gas, nausea, and indigestion
• Abdominal bloating, pelvic and/or abdominal pain, and/or feeling of fullness
• Unexplained change in bowel habits (constipation or diarrhea)
• Unexplained weight gain or loss
• Frequency and/or urgency of urination
• Unusual fatigue
• Shortness of breath
• New and unexplained abnormal postmenopausal vaginal bleeding
• Increasing age, with highest occurrence in women over 50
• Family or personal history of ovarian, breast, endometrial, or colon cancer
(only 10% of cases are linked to family history, however)
• Uninterrupted ovulation (having no pregnancies; infertility, low parity)
• Presence of BRCA1 or BRCA 2 gene mutations
How is Ovarian Cancer Diagnosed?
• The PAP test is used to detect cervical cancer, NOT ovarian cancer.
• A vaginal-rectal pelvic examination (also called a bimanual exam) – This exam allows the ovaries to be examined from many sides. Every woman should undergo a rectal and vaginal pelvic examination at her annual check up with her gynecologist.
• Transvaginal Ultrasound – This test uses sound waves to create a picture of the ovaries, and can often reveal if there are masses or irregularities on the surface of the ovaries. It cannot determine if you have cancer but it can show characteristics that give different levels of suspicion.
• CA125 blood test – This test measures the level of a substance in the blood that may increase when a cancerous tumor is present; this protein is produced by ovarian cancer cells and is elevated in more than 80% of women with advanced ovarian cancers and 50% of those with early-stage cancers. Because CA125 misses half of early cancers and can be elevated by benign conditions, the National Cancer Institute (NCI) does not endorse using it to screen women at ordinary risk or in the general population.
• It is very important to note that none of these tests are definitive when used on their own. They are most effective when used in combination with each other. The only way to confirm the presence of ovarian cancer suspected by the above tests is through a surgical biopsy of the tumor tissue.
Most ovarian cancers can be subdivided by their “stage” and “grade”. Dividing cancers into these categories is helpful in determining appropriate treatment and prognosis. “Stage” basically describes the location of the tumor at the time of diagnosis. All gynecologic cancers are divided into 4 “Stages”. The stage given a cancer at the initial diagnosis does not change.
“Grade” refers to the appearance of the individual cancer cells under the microscope. Gynecologic cancers are generally divided into three Grades. Grade 1 cancers have an appearance not too dissimilar to the normal native tissue from which it arises. Grade 3 cancers bear little resemblance to the tissue of origin.
• Stage I: Cancer is confined to one or both ovaries. When cancer is diagnosed at this stage, a woman has a 95% chance of being cured. Unfortunately, only 25% of cases are found at Stage I.
• Stage II: Cancer is in one or both ovaries and has spread to other part of the pelvis.
• Stage III: Cancer is in one or both ovaries, and has spread to nearby lymph nodes or to other abdominal organs, excluding the liver.
• Stage IV: Cancer is in one or both ovaries, and has spread to the liver or sites outside the abdomen.
An additional goal of surgery is to remove as much malignant material as possible. Unless the disease is confined to ovary, the surgery usually involves removing both ovaries, the uterus, fallopian tubes, and the omentum, a layer of fatty tissue that covers the intestines.
Typically, surgery is followed by chemotherapy. Standard first-line chemotherapy combines two drugs, carboplatin and paclitaxel. Because new anti-nausea drugs have gone a long way towards eliminating stomach discomfort and vomiting during chemotherapy, patients can often return to their normal activities soon after surgery. During and after chemotherapy, doctors monitor women’s progress via pelvic exams, CT scans, and with the CA-125 blood test. While the CA-125 isn’t a fool-proof screening test for ovarian cancer, it does reliably indicate whether the disease is recurring in women who have already been treated. Because of individual differences, every woman should discuss treatment options with her physician.
Why is it so important to be treated by a gynecologic oncologist?
The importance of being treated by a gynecologic oncologist cannot be stressed enough. According to numerous medical studies, there are significant survival advantages for those women who are treated, managed, and operated on by a gynecologic oncologist.
• A gynecologic oncologist is a professional who specializes in treating women with reproductive tract cancers.
• Gynecologic oncologists are initially trained as obstetrician/gynecologists and then undergo three-four years of specialized education in all of the effective forms of treatment for gynecologic cancers (surgery, radiation, chemotherapy and experimental treatments) as well as the biology and pathology of gynecologic cancers.
• Gynecologic oncologists are 5 times more likely to completely remove ovarian tumors during surgery.
• 80% of ovarian cancer patients receive inadequate surgical debulking and staging from non-gynecologic oncologist surgeons.
• Survival rate and outcomes vastly improve with gynecologic oncologists.